EMS providers know well the daily tragedies repre- sented by the following three cases, where young or otherwise healthy individuals succumb to sudden
and unexpected illness or injury.
Although prehospital personnel make remarkable saves,
many previously healthy patients die of medically reversible
causes, despite excellent prehospital care, simply because standard resuscitative practice can’t provide
sufficient cardiopulmonary support during severe derangements of heart and/or lung function to
allow time for recovery or definitive treatment of the immediate cause.
Case I: Witnessed Out-of-Hospital Cardiac Arrest
Your crew responds to the scene of a 55-year-old male who was witnessed to collapse while walking in
the park with his wife. Bystanders immediately started chest compressions and called 9-1-1.
On arrival, the patient has been pulseless for nearly 10 minutes. While performing high-quality
chest compressions, you place the patient on the monitor and note an initial rhythm of ventricular
fibrillation (v fib).
An initial shock of 120 J produces a transient organized rhythm before v fib recurs. Two subsequent
shocks are administered along with a bolus dose of amiodarone. The patient then develops a rhythm
indicating idioventricular pulseless electrical activity (PEA).
A definitive airway is established by your partner and after 45 minutes of field efforts, the patient
is still in PEA. You call online medical control regarding the decision to transport and the physician
at the local receiving hospital reviews the care administered so far and says, “We have nothing else to
ECMO & ECPR
The new load & go destination for cardiac arrest?
By Sean Slack, DO;
Hill Stoecklein, MD;
Joseph E. Tonna, MD, FAAEM
& Scott T. Youngquist, MD, MS,